18F-fluorodeoxyglucose positron emission tomography in the staging and prognosis of T cell lymphoma Journal Article
| Authors: | Casulo, C.; Schoder, H.; Feeney, J.; Lim, R.; Maragulia, J.; Zelenetz, A. D.; Horwitz, S. |
| Article Title: | 18F-fluorodeoxyglucose positron emission tomography in the staging and prognosis of T cell lymphoma |
| Abstract: | We previously reported that 18F-fluorodeoxyglucose positron emission tomography scan (FDG-PET) is almost universally positive in patients with T cell lymphoma. In the present analysis we examined the impact of FDG-PET on the initial staging of peripheral T cell lymphomas (PTCLs), and the prognostic value of interim FDG-PET. This retrospective analysis identified patients with mature T or natural killer (NK) lymphomas who had PET scans as part of initial staging or staging at relapse [(n = 95) (staging cohort)] in the PTCL database at Memorial Sloan-Kettering Cancer Center. A subset of these patients had repeat PET for interim restaging during initial therapy with curative intent [(n = 50) (interim restaging cohort)]. The frequency of specific T cell histologies included in this analysis were: PTCL not otherwise specified (NOS) (n = 35); angioimmunoblastic T cell lymphoma (AITL) (n = 17); anaplastic large cell lymphoma (ALCL), ALK-1+ (n = 11) and ALK-1- (n = 12); adult T cell lymphoma/leukemia (ATLL) (n = 7); NK/T cell lymphoma (NKTCL) (n = 10); and enteropathy-associated T cell lymphoma (EATL) (n = 3). In the staging cohort, 77 patients were newly diagnosed, and 18 had relapsed disease. Pretreatment FDG-PET was positive in 96% of patients. PET identified additional disease sites in 47/95 patients (50%) when added to conventional staging. Most frequently identified additional sites were: other nodal (n = 24); bone (n = 10); skin (n = 8); nasopharynx (n = 4); spleen (n = 3); and lung (n = 2). However, FDG-PET modified computed tomography (CT)-based staging in only 5/95 patients (5.2%): two patients were upstaged and three patients were downstaged. FDG-PET-based staging did not alter planned treatment for any patient. Interim restaging with PET was performed after a median of 4 cycles of chemotherapy. In this cohort, treatment regimens included cyclophosphamide, doxorubicin, vincristine and prednisone CHOP (n = 19); CHOP/ifosfamide, carboplatin and etoposide (ICE) (n = 26); and other (n = 7). Subsequently, 29 patients were consolidated with either autologous (n = 22) or allogeneic (n = 7) stem cell transplant. After a median follow-up of 3.4 years for surviving patients, those with negative interim PET had superior progression-free survival (PFS) compared to patients with positive interim PET (p = 0.03). There were no differences in overall survival (OS). In PTCL, FDG-PET commonly identifies additional sites of disease but infrequently impacts CT-based staging and does not influence therapy. Interim FDG-PET may predict for PFS. FDG-PET should be integrated into prospective trials to confirm these findings. © 2013 Informa UK, Ltd. |
| Keywords: | adult; major clinical study; overall survival; prednisone; allogeneic stem cell transplantation; doxorubicin; cancer combination chemotherapy; treatment planning; cancer staging; positron emission tomography; follow up; staging; carboplatin; progression free survival; computer assisted tomography; spleen; etoposide; relapse; cyclophosphamide; vincristine; retrospective study; histology; ifosfamide; skin; t cell lymphoma; fdg-pet; fluorodeoxyglucose f 18; bone; lung; large cell lymphoma; nasopharynx; cancer prognosis; lymphoma and hodgkin disease; enteropathy associated t cell lymphoma |
| Journal Title: | Leukemia and Lymphoma |
| Volume: | 54 |
| Issue: | 10 |
| ISSN: | 1042-8194 |
| Publisher: | Taylor & Francis Group |
| Date Published: | 2013-10-01 |
| Start Page: | 2163 |
| End Page: | 2167 |
| Language: | English |
| DOI: | 10.3109/10428194.2013.767901 |
| PROVIDER: | scopus |
| PUBMED: | 23369041 |
| PMCID: | PMC3915724 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 October 2013" - "CODEN: LELYE" - "Source: Scopus" |
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